Carotid Endarterectomy vs. Carotid Stenting

A recent National Institutes of Health (NIH) study compared different available treatment options for managing plaque build up in the carotid arteries. The goal of this study was to help researchers determine the most optimal treatment approaches for individual patients. One of the lead authors of this study, Dr. Brajesh Lal, a vascular surgeon at the University of Maryland Medical Center, answers some common questions about what researchers uncovered below.

What was the title of this study?

This study was known as the CREST study, which stands for Carotid Revascularization Endarterectomy Versus Stenting Trial.

What were the results of this study?

From this study, we found that a lot of things are now changing in the management of vascular disease, and as a specialist in this field, I am tremendously excited about that. In addition to traditional open surgery, we can now manage vascular disease through minimally invasive methods such as stenting and ballooning, as well as with alternative treatment options such as pharmacological management in the form of statins and anti-platelet therapies. But, most importantly, we learned that we can mix and match these approaches to formulate the most optimal methods for treating individual patients.

Why is it important for doctors to be able to "mix and match" different treatment options?

The ability for doctors to combine different approaches in the treatment of vascular disease is important because, for instance, there are times when a doctor has to perform a stenting in one location of an artery in order to support a bypass in another location of the same artery. The reverse of this situation can also be true. Meanwhile, we also need to manage patients with pharmacological therapy to support both the stenting and the bypass. There are also other occasions where one treatment, either stenting or open surgery, may be preferred over another for a particular patient.

What does this mean for patients?

Patients who have vascular disease should meet with a vascular specialist who can offer them all three treatment options, including medical management, stenting and surgery. This will ensure that those patients receive the most unbiased opinion of what will work best for them. It also ensures that their physician will have the ability to mix and match these different options so that patients receive the best combined management possible.

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